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Home-based organizations need to take on more value-based care, says Dr. Mark McClellan

As the number of COVID-19 cases is still increasing, the country is not where it needs to be to safely reopen, he says.

Mallory Hackett, Associate Editor

Photo by Lisa Lake/Getty Images for Geisinger Health System.Photo by Lisa Lake/Getty Images for Geisinger Health System.

The number of new COVID-19 cases should make people cautious about reopening, said Dr. Mark McClellan, the director of the Robert J Margolis Center for Health Policy, as well as a former commissioner of the Food and Drug Administration and administrator of the Centers for Medicare and Medicaid Services. 

"Overall, the country is running around 20,000 new cases per day and maybe 1,000 new hospitalizations per day," he said during AHIP's Institute and Expo. "We've got time to respond to all of that, but we're definitely not where we'd ideally like to be at this point."

If the numbers keep increasing, it's likely that states will have to take serious measures such as shutting down again to prevent a surge from happening in them.

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Telehealth has helped the industry during the pandemic, and that may be helpful in the future.

"We've seen more progress in the last two months, three months on telemedicine adoption than we've seen in the last, you know, 20 or 30 years," McClellan said. "When people had to do it, they started doing it."

While this is a step in the right direction, McClellan thinks more needs to be done for the long-term success of the healthcare industry.

To do so, the government needs to keep supplying relief to healthcare organizations and allow for at-home care to continue at the level it is now. Organizations also need to be willing to switch away from a fee-for-service payment model to something more value-based. 

"The future coming out of this will hopefully be much more home-based, much more convenient for patients and less costly as we head into what will be some challenging economic times in the year ahead," McClellan said. 

For businesses that feel pressure to get their employees back to work and their operations running again, it's important to take reasonable steps towards reopening and not go too fast. 

He urged companies to consider their community's level of infection and guidance from public health organizations such as the Centers for Disease Control and Prevention and industry-specific associations when coming up with a plan for opening.

Specifically, he recommended wearing masks, maintaining social distancing, regular handwashing and doing daily temperature checks. 

"It's a lot of things to think about and it's important, also, to try to encourage these same kinds of behaviors in your workers and customers, and make it easy for them to do," McClellan said.

For businesses that are at high risk, like hospitals, nursing homes and other frontline settings, he also said that regular testing can be effective.

"I think that testing will become a more regular part of activities there, especially in communities where there are significant outbreaks going on," McClellan said.

Health systems can also look into bringing in a partner for a more holistic prevention model.

"They should be aiming for getting away from a contract that pays on a test-by-test basis or suggesting their employees go off somewhere else to get testing," McClellan said. 

As far as a COVID-19 vaccine, McClellan said he's never witnessed anything like the current investments being made to find a vaccine, potentially by the end of the year.

"There's a lot of ifs that still need to take place between now and then, but I've never seen anything like this degree of effort around making this a much faster process, hopefully without cutting corners on safety and effectiveness," he said. 

Because this process is being done so quickly, some vaccines will be available before all of the evidence is collected. 

"The ones that come along first are probably not going to be perfect," McClellan said.

Think of the flu vaccine.  

"(The) flu vaccine-quality is not something like a smallpox vaccine that you can reliably think is going to work," he said. "So we're going to have to keep making them better, but that's the way vaccine innovation occurs." 

Twitter: @HackettMallory
Email the writer: mhackett@himss.org